Friday, July 27, 2012

Overwhelmed VA didn't happen overnight

VA secretary vs. Obama and his lousy record on vets
By Jennifer Rubin
We noted yesterday that the president’s speech at the Veterans of Foreign Wars convention was promptly undercut by Defense Secretary Leon Panetta. He wasn’t the only Cabinet member to contradict the president.
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Overwhelmed VA didn't happen overnight
by Chaplain Kathie
Wounded Times Blog
July 27, 2012

If you read this blog often you know I am far from happy with what has been going on with our veterans. I swear, if the general public knew half of what is really going on they would be screaming at every member of congress they elected since 2001!

The fact that two wars, Afghanistan and then Iraq, were never in the budget, or paid for until President Obama included them was a glaring indication of how little these wars mattered to the Congress. Everything was done with supplemental requests and we heard members of Congress tell the American public how important they were to be worth the risk to the men and women sent to fight in them and risk being killed or wounded for.

With all the talk about what a mess the VA is in, it is a good time to reflect on how it got as bad as it is. The bottom line is, it took Congress and two other Presidents to get things as bad as they are an another President trying to get something done with a Congress that won't do much at all. Not that President Obama is pushing as hard as he can to catch up but at least he's trying.

“The system is going to be overwhelmed,” Panetta said. “Let’s not kid ourselves. It’s already overwhelmed.”

Panetta, Shinseki acknowledge frustration in streamling military health care
Published: July 26

Secretary of Defense Leon E. Panetta and Secretary of Veterans Affairs Eric K. Shinseki acknowledged Wednesday that they have been frustrated by departmental bureaucracy in their attempts to streamline military health care for severely wounded service members.

At a rare joint appearance before the House Armed Services and House Veterans Affairs committees, the secretaries pointed to what they called unprecedented cooperation between their two departments in battling some of their most pressing problems, including the high rate of military suicide and the huge backlog of disability claims.

But they have been unable to consolidate separate VA and Department of Defense programs to coordinate the long-term recovery of seriously wounded service members, despite warnings from the Government Accountability Office that the proliferation of programs might increase red tape.

“Secretary Shinseki and I share the same frustration,” Panetta said in response to questioning from Rep. Ann Marie Buerkle (R-N.Y.) “We’ve been working on this, and frankly, we’ve been pushing, to try to say why can’t we get faster results, why can’t we get this done on a faster track.

“Bottom line is, frankly, we’re just going to have to kick ass and try to make it happen, and that’s what we’re going to do.”

Shinseki said the separate VA and defense programs “don’t quite harmonize” and that the issue remains under study, as it was last year. He said the departments hope to report back to Congress in several months on their efforts to eliminate duplication.

The Washington Post reported in November that despite the recommendations of the Dole-Shalala commission in 2007 to create a single point of contact to cut red tape for the most severely wounded service members, the Defense Department and the VA had created at least a dozen programs to coordinate care.
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Major Appropriation Issues
Stewardship of Resources
 Supports management systems that ensure accountability, maximize efficiency and effectiveness, and eliminate waste while improving the delivery of high quality and timely benefits and services to Veterans.

Medical Care
 Secures timely, predictable funding for health care through 2014 with advance appropriations
 $1.352 billion (up $333 million) to further VA’s integrated plan to end Veteran homelessness, including $235 million for the Homeless Grants and Per Diem program to aid community organizations
 $6.2 billion (up $312 million) to expand inpatient, residential, and outpatient mental health programs
 $7.2 billion (up $550 million) to expand institutional and non- institutional long-term care services.
 $335 million (up $9 million) is for tele-home health to improve access to care
 $403 million (up $60 million) for the needs of women Veterans
 $3.3 billion (up $510 million) to meet the needs of over 610,000 Veterans returning from U.S. operations in Iraq and Afghanistan

Veterans Job Corps
 A Presidential initiative of $1 billion over the next five years to establish a conservation program impacting up to 20,000 veterans to protect and rebuild America’s land and resources.

Benefits Claims Processing
$2.164 billion (up $145 million over 2012) to support improved benefits processing through increased staff, improved business processes, and information technology enhancements
Supports the completion of 1.4 million disability compensation and pension claims, a 36% increase over 2011
Provides funding to complete 4 million education claims, a 19% increase over 2011 National Cemetery Administration
 $258 million for operations and maintenance to ensure VA’s cemeteries are maintained as national shrines
 The budget provides funding to expand access to burial options for rural Veterans.

Information Technology
 80% of 2013 IT Budget supports direct delivery of medical care and benefits to Veterans
 Over $3.3 billion for a reliable and accessible IT infrastructure, a high-performing workforce, and modernized information systems for Veteran services and benefits
 $53 million for development and implementation of the Virtual Lifetime Electronic Record (VLER) initiative
 $169 million for integrated Electronic Healthcare Record (iEHR), a joint effort with DoD to share health information
 $128 million for paperless claims processing system VBMS Construction
 Supports four major medical facility projects already underway. Entitlement Benefits
 $76.3 billion for mandatory benefits, including compensation for Agent Orange presumptive conditions and Post-9/11 GI Bill education benefits

The really interesting thing is what happened for the 2003 budget when troops had been in Afghanistan for a year when the budget was being calculated. Remember, budgets are done a year before by whatever President/Congress is in office.

Administration Announces FY 2003 Budget
Taken from the Veterans Health Administration Highlights
dated February 8, 2002

VA Secretary Anthony J. Principi announced details of President Bush’s proposed $58 billion VA budget, which recommends $25.5 billion for the VA health care system.
Other features of the proposed budget include:
An almost $366 million increase for pharmaceuticals, that would bring the total to $2.9 billion in 2003
$409 million for medical and prosthetics research, a $38 million increase from this year’s spending level
$537 million for construction and grants

The FY 2003 budget proposes to establish a $1,500 yearly deductible for medical services for higher income, non-service-connected veterans. This would not be a standard deductible that must be paid upfront. The veteran would be charged 45 percent of VA’s "reasonable charges" each time care is provided until the $1,500 annual ceiling for deductible expenses is reached.

If the veteran has third-party health insurance, VA would bill the insurance company first, for the full cost of care. Payments from the insurance companies would be applied to the deductible amount owed by the veteran.

Medication copayments would not count toward the deductible amount, but would be charged at the existing rate of $7 for each 30-day prescription. Deductible charges would not be made for visits for preventive care only. After the $1,500 deductible limit is met, the veteran would then pay the normal copayments that are charged for outpatient and inpatient care.

"This initiative denies care to no one. It does ask those veterans who have the means and who incurred no disabilities on active duty, to pay a larger portion of their health care," Secretary Principi said. "That seems fair to me and allows VA to provide the best care possible to our higher priority veterans."

Listen to this hearing on the 2003 Budget
"208 days for claims to be processed." Senator Nelson Rockefeller.

By 2007 the VA was in such a mess that this happened.

U.S. Veterans Affairs Secretary Jim Nicholson Quits
By Neil Roland
July 17, 2007

Jim Nicholson, the U.S. secretary of veterans affairs, will resign by Oct. 1 after heading a health- care network that is sagging under the weight of returning combatants from Iraq and Afghanistan.

``I feel it is time for me to get back into business, while I still can,'' Nicholson, a member of President George W. Bush's cabinet, said in an e-mailed Veterans Affairs Department statement.

Nicholson, 69, who served in Vietnam, has headed the $77 billion Veterans Affairs Department since February 2005, a month after Bush's second term began. He was U.S. ambassador to the Vatican during Bush's first term, and before that was chairman of the Republican National Committee from 1997 to 2000. In the private sector, he had run a residential development and construction company.

The VA's network of 1,400 medical centers, clinics and nursing homes has been criticized by Democratic lawmakers who said last month it hasn't done enough to care for 263,000 returning Iraq and Afghanistan veterans.

Had Congress actually kept up with funding for what was needed, the veterans would not be suffering the way they are now.
Senate Committee Veterans Affairs
Veterans' Hospitals Consolidation and Closure
September 11, 2003

Witnesses testified about a proposal to scale back, consolidate or close selected Veterans' Administration health care facilities.

The other issue here is that while the VA budget during the Bush Administration was increasing disabled veterans from 2001 when troops were sent into Afghanistan and 2003 when more were added from Iraq, the VA was never fully funded to be ahead of the influx of more wounded coming home.

President Bush's first budget was not for 2001 when he was inaugurated. His first budget took affect in 2002 after troops went into Afghanistan.

That is the biggest thing that keeps getting missed in all of this. President Obama has been slammed lately primarily by the people who caused the problem in the first place,,,,Congress.

As you can see with veterans from two wars getting wounded, surviving at a higher percentage than ever before, along with Vietnam Veterans finally having the ability to go to the VA with Agent Orange and PTSD claims, Congress didn't keep up with the money needed to do it.

Now think of this.
2001 President Clinton's Budget (Bush's First term)
VA's 2001 budget would provide $48 billion for the fiscal year that begins Oct. 1, 2000.

2002 President Bush's Budget
The 2002 budget provides $23,378 million in discretionary funding for veterans health, benefits, and other services, including $23,998 million in gross discretionary budget authority and $620 million in anticipated discretionary medical collections.
This funding level recognizes that an estimated $235 million of current medical care liabilities will shift to the Department of Defense due to new benefits available to military retirees over age 64.

Last year, VA treated 1.4 million more veterans with 20,000 fewer employees than in 1996," said Principi. January 17, 2003

2003 President Bush's Budget
2004 President Bush's Budget
2004 Budget includes a total of $63.6 billion for VA -- $30.2 billion in discretionary funding (mostly for health care) and $33.4 billion for VA-administered entitlement programs (mostly disability compensation and pensions). The budget includes $225 million in new construction funding for VA's nationwide infrastructure initiative (CARES) to ensure that VA can put services where veterans live.

2005 President Bush's Budget
2006 President Bush's Budget
2007 President Bush's Budget
2008 President Bush's Budget
2009 President Bush's Budget (Obama's first term)

2009: $97.7 billion (total including collections) -- $50.4 billion in discretionary funding (including collections, not including ARRA funds) and $47.3 billion in mandatory funding

2010 President Obama's Budget
2010 Budget: $112.8 billion (total including collections) – $55.9 billion in discretionary funding (including collections) and $56.9 billion in mandatory funding

2011 President Obama's Budget
Department of Veterans Affairs Budget Request for Fiscal Year 2011 and Fiscal Year 2012.
The President has requested a budget for VA of $125 billion, including a total discretionary resource request of $60.3 billion. VA medical care represents 86 percent of the total discretionary request. For fiscal year 2011, the Administration is requesting $51.5 billion in resources for VA medical care. Appropriated resources for medical care for fiscal year 2011 have already been provided in last year’s Consolidated Appropriations Act. This funding level is an increase of $4.1 billion, or 8.6 percent over fiscal year 2010 levels.

2012 President Obama's Budget

This gives you some idea of what the media consistently fails to do. Remind people that the problems with the VA didn't start this year. They start when there is a failure to plan ahead.

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